Total Burn Care
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* Edward E. Tredget

**TOTAL BURN CARE.** Edited by D.N. Herndon. 597 pp. Illust. W.B. Saunders Company Ltd., London, UK; W.B. Saunders Canada, Toronto. 1996. $163. ISBN 0-7020-1827-9

This text is a comprehensive assemblage of 60 chapters from 82 authors. It describes in detail the management of the thermally injured patient from the prehospital and emergency room phases to the critical care unit and the operating room, and finally the rehabilitation and psychological recovery of the patient.

The contributions are from experts in burn care not only from the United States but also from Japan, Australia and Europe; thus, the book presents a worldwide perspective. Twelve of the authors are past presidents of the American Burn Association. The editor is chief of staff at the Shriners’ Burn Institute in Galveston, Tex.

Consistent with modern burn care, the opening chapter deals with the teamwork for total and comprehensive management of the burn patient, a recurring theme within the text.

Important, yet often-neglected aspects of prehospital care, disaster management and epidemiology and demographics are discussed in the subsequent early chapters, before wound pathogenesis and fluid resuscitation. In a broad unbiased discussion, the current range of regimens for fluid resuscitation is simplified and clearly defined (including the author’s preferred approach), making this chapter very informative for the inexperienced and specialist alike.

The strong research program of the Shriners’ Burn Institute in Galveston is apparent in the well-written, practical discussion of three chapters that cover pathophysiology, diagnosis, treatment and respiratory care of inhalation injuries. Similarly, the expertise of this institution is exploited for well-written, concise chapters that discuss the metabolic response to injury, pathophysiology of the systemic inflammatory response syndrome, and modulation of the wound healing and postburn response. In these chapters are discussed the understanding of the metabolic response to burn injury, through the use of stable isotopes, and the current basis and status of hormonal and growth-factor modulation of the wound healing response.

An important discussion of renal failure in burn patients is included. This is of great practical importance for patient management, yet has not been covered in pre-existing texts of burn care. This topic is also touched upon in a very useful section dealing with intensive-care requirements and in descriptions of critical-care complications in subsequent chapters.

The range of burn care includes burn nursing, specialized approaches to the pediatric and geriatric burn patient, a comprehensive section dealing with frostbite, electrical injuries, chemical and radiation injuries as well as exfoliative disorders. There is an authoritative discussion of alternatives to wound coverings for patients lacking donor sites for autografts, with an algorithm for decision making with respect to the indications for emerging technologies. Realistic suggestions for the use of cultured epithelial autografts are outlined, on the basis of the clinical experience to date, and there is a timely discussion of the conceptual and practical use of dermal replacements that is nicely illustrated by colour photographs.

Also in the text are a series of chapters on burn reconstruction, including the overall approach and specific anatomic areas, such as the head and neck, scalp, hand and foot. Finally, experienced practitioners are aware of the importance of rehabilitation, including the physical and psychological components, for the burn patient, all of which are discussed in chapters ranging from pain management, psychiatric disorders, abuse by burning, reintegration into society and ethical decision making for burn patients.

Overall, I agree with the assessment of the text in the foreword by Dr. Basil Pruitt, Jr., himself the author of most authoritative chapters in burn care to date, that this text is highly recommended for every medical school and burn centre library and for all members of the team caring for burned patients.